8. Material Submittal Form (002).pdf

MATERIAL APPROVAL SUBMITTAL

TO: USDA/ARS

CO CC: Technical

POC

FROM: (Contractor) PROJECT TITLE: CONTRACT NUMBER:

(To be completed by the Contractor) Government Use Only

SUBMITTAL

NUMBER:

PREVIOUS SUBMITTAL NUMBER

(only if items listed were submitted previously):

Technical POC

Recommendation

Contracting Officer Approval/Disapproval

Line

No.

Specification Sect.

Para No., Draw No.

Description of Material

(Include type, model, mfg) APP DISAP

See

Comments on Reverse APP DISAP

See

Comments on

Reverse

If an item is disapproved, a resubmittal is due within ________ calendar days of the Contracting Officer’s signature below.

Contractor Technical POC Contracting Officer TYPE or PRINT NAME & TITLE TYPE or PRINT NAME & TITLE TYPE or PRINT NAME & TITLE

SIGNATURE: SIGNATURE: SIGNATURE:

DATE: DATE: DATE:

By completing this form, the above signed contractor certifies that the material complies with all specifications of the subject contract.

DATE RECEIVED FROM Contractor: DATE RECEIVED FROM COR:

Material Approval Submittal Cover Sheet (11/2016)

CONTRACT #: SUBMITTAL #:

COMMENTS

Instructions: Enter the initials of the individual making the comment, the Line Number of the item for which the comment is being made, and the comment.

Material Approval Submittal Cover Sheet (11/2016) (Reverse)